"Exclusively aligned enrollment" (EAE) occurs when a state restricts enrollment in a Medicare Advantage dual eligible special needs plan (D-SNP) to full-benefit dually eligible individuals who receive Medicaid benefits from the D-SNP or an affiliated Medicaid managed care plan offered by the same parent organization as the D-SNP. This technical assistance brief is part of ICRC's series of tools on EAE. It outlines key steps and considerations for states implementing EAE using a "Medicare-first" approach (meaning the state matches a dually eligible individual's Medicaid enrollment to their choice of D-SNP enrollment). The tips and considerations within this brief are applicable for states in which integrated D-SNPs are “aligned” with “affiliated” Medicaid managed care plans offered by the same parent organization as the D-SNP, as well as for states that choose to directly capitate D-SNPs to cover Medicaid benefits for their enrollees.
This brief provides: 1) an overview of the MA enrollment process; (2) a summary of key steps in aligning Medicaid coverage with D-SNP enrollment; 3) key decisions for states interested in using Medicare-first EAE; 4) examples of common enrollment and disenrollment scenarios for states to consider when designing Medicare-first EAE processes; and 5) descriptions of the files through which states can learn about D-SNP enrollments and disenrollments.
Authors: Lida Momeni, Gretchen Bell, and Nancy Archibald, Center for Health Care Strategies; Elizabeth Boystak, Katerín Fernández, and Erin Weir Lakhmani, Mathematica